Invokana

Assess renal function prior to starting and as clinically indicated. Prior to initiation, assess and correct volume status in those with renal impairment, elderly, or on loop diuretics; monitor during therapy. Precipitating conditions for diabetic ketoacidosis (acute febrile illness, reduced caloric intake, ketogenic diet, surgery, insulin dose reduction, volume depletion, and alcohol abuse). Assess for ketoacidosis in presence of signs/symptoms of metabolic acidosis, regardless of blood glucose levels; discontinue if suspected; evaluate and treat if confirmed. Monitor for resolution of ketoacidosis before restarting. Withhold (at least 3 days), if possible, prior to major surgery or procedures associated with prolonged fasting. Increased risk for lower limb amputations. Consider risk factors that may predispose to amputations prior to initiation (eg, prior amputation, peripheral vascular disease, neuropathy, diabetic foot ulcers). Monitor for foot infection (including osteomyelitis), new pain or tenderness, sores or ulcers in lower limbs; discontinue if occur. Necrotizing fasciitis of the perineum (Fournier's gangrene); discontinue and treat immediately if suspected; use alternative antidiabetic. Monitor for genital mycotic infections, UTIs (including urosepsis, pyelonephritis); treat if indicated. Discontinue if hypersensitivity reactions occur; treat and monitor until resolved. Consider bone fracture risks before initiation. Renal impairment. Severe hepatic impairment: not recommended. Pregnancy (during 2^nd & 3^rd trimesters), nursing mothers: not recommended.